Aims. The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries and examined the effect of a range of demographic- and injury-related variables on these outcomes. Methods. In total, 101 patients (53 female, 48 male) with a mean age of 50.9 years (19 to 76) with minimally displaced GT fractures were recruited to a prospective observational cohort study. During the first year after injury, patients underwent experiential assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score and assessment of associated injuries using MRI performed within two weeks of injury. The primary outcome was the one-year DASH score. Multivariate analysis was used to assess the effect of patient demographic factors, complications, and associated injuries, on outcome. Results. The mean DASH score improved from 42.3 (SD 9.6) at six weeks post-injury, to 19.5 (SD 14.3) at one-year follow-up (p < 0.001), but outcomes were mixed, with 30 patients having a DASH score > 30 at one year. MRI revealed a range of associated injuries, with a full-thickness rotator cuff tear present in 19 patients (19%). Overall, 11 patients (11%) developed complications requiring further operative intervention; 20 patients (21%) developed post-traumatic secondary shoulder stiffness. Multivariate analysis revealed a high-energy mechanism (p = 0.009), tobacco consumption (p = 0.033), use of
This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired rotator cuff tendon was assessed using the Sugaya classification. Tendon thickness at the footprint was evaluated on T2-weighted oblique coronal view.Aims
Methods
The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR). This retrospective study included 133 consecutive patients with a mean age of 30 years (14 to 69) who underwent ABR-HSR; 103 (77%) practiced sports before the instability of the shoulder. All had large/deep, engaging Hill-Sachs lesions (Calandra III). Patients were divided into two groups: A (n = 102) with minimal or no (< 10%) glenoid bone loss, and B (n = 31) with subcritical (10% to 20%) glenoid loss. A total of 19 patients (14%) had undergone a previous stabilization, which failed. The primary endpoint was recurrent instability, with a secondary outcome of the ability to return to sport.Aims
Methods
This study aimed to determine the minimal detectable change (MDC), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) under distribution- and anchor-based methods for the Mayo Elbow Performance Index (MEPI) and range of movement (ROM) after open elbow arthrolysis (OEA). We also assessed the proportion of patients who achieved MCID and SCB; and identified the factors associated with achieving MCID. A cohort of 265 patients treated by OEA were included. The MEPI and ROM were evaluated at baseline and at two-year follow-up. Distribution-based MDC was calculated with confidence intervals (CIs) reflecting 80% (MDC 80), 90% (MDC 90), and 95% (MDC 95) certainty, and MCID with changes from baseline to follow-up. Anchor-based MCID (anchored to somewhat satisfied) and SCB (very satisfied) were calculated using a five-level Likert satisfaction scale. Multivariate logistic regression of factors affecting MCID achievement was performed.Aims
Methods
Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article:
The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair.Aims
Methods
The aim of this study was to evaluate the differences in revision and complication rates, functional outcomes, and radiological outcomes between cemented and press-fit humeral stems in primary anatomical total shoulder arthroplasty (TSA). A comprehensive systematic review and meta-analysis was conducted searching for studies that included patients who underwent primary anatomical TSA for primary osteoarthritis or rheumatoid arthritis.Aims
Materials and Methods
To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction.Objectives
Methods
The aim of this study was to report the mid-term clinical outcome
of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties
when used in patients with rheumatoid arthritis (RA). We retrospectively reviewed 87 elbows, in 75 patients with RA,
which was replaced using a cemented JACE total elbow arthroplasty
(TEA) between August 2003 and December 2012, with a follow-up of
96%. There were 72 women and three men, with a mean age of 62 years
(35 to 79). The mean follow-up was nine years (2 to 14). The clinical condition
of each elbow before and after surgery was assessed using the Mayo
Elbow Performance Index (MEPI, 0 to 100 points). Radiographic loosening
was defined as a progressive radiolucent line of >1 mm that was
completely circumferential around the prosthesis.Aims
Patients and Methods
Aims. Controversy about the use of an anatomical total shoulder arthroplasty
(aTSA) in young arthritic patients relates to which is the ideal
form of fixation for the glenoid component: cemented or cementless.
This study aimed to evaluate implant survival of aTSA when used
in patients aged < 60 years with primary glenohumeral osteoarthritis (OA),
and to compare the survival of cemented all-polyethylene and cementless
metal-backed glenoid components. Materials and Methods. A total of 69 consecutive aTSAs were performed in 67 patients
aged < 60 years with primary glenohumeral OA. Their mean age
at the time of surgery was 54 years (35 to 60). Of these aTSAs,
46 were undertaken using a cemented polyethylene component and 23
were undertaken using a cementless metal-backed component. The age, gender,
preoperative function,
The aim of this study was to analyze the results of reverse shoulder
arthroplasty (RSA) in patients with type 1 sequelae of a fracture
of the proximal humerus in association with rotator cuff deficiency
or severe stiffness of the shoulder. A total of 38 patients were included: 28 women and ten men. Their
mean age at the time of arthroplasty was 73 years (54 to 91). Before
the RSA, 18 patients had been treated with open reduction and internal
fixation following a fracture. A total of 22 patients had a rotator
cuff tear and 11 had severe stiffness of the shoulder with < 0°
of external rotation. The mean follow-up was 4.3 years (1.5 to 10).
The Constant score and the range of movement of the shoulder were
recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as
well as CT or arthro-CT scans; radiographs were also performed at
final follow-up.Aims
Patients and Methods
Since long-term outcome of teres major tendon transfer surgery
for irreparable posterosuperior rotator cuff (RC) tears is largely
unknown, the primary aim of this study was to evaluate the long-term
outcome of the teres major transfer. We also aimed to report on
the results of a cohort of patients with a similar indication for
surgery that underwent a latissimus dorsi tendon transfer. In this prospective cohort study, we reported on the long-term
results of 20 consecutive patients with a teres major tendon transfer
for irreparable massive posterosuperior RC tears. Additionally,
we reported on the results of the latissimus dorsi tendon transfer
(n = 19). The mean age was 60 years (47 to 77). Outcomes included
the Constant score (CS), and pain at rest and during movement using
the Visual Analogue Scale (VAS).Aims
Patients and Methods
The aim of this retrospective multicentre study was to evaluate
mid-term results of the operative treatment of Monteggia-like lesions
and to determine the prognostic factors that influence the clinical
and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age
of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion
were followed up clinically and radiologically after surgical treatment.
The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score
(MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder
and Hand (DASH) score were used for evaluation at a mean of 65 months
(27 to 111) postoperatively. All ulnar fractures were stabilized
using a proximally contoured or precontoured locking compression
plate. Mason type I fractures of the radial head were treated conservatively, type
II fractures were treated with reconstruction, and type III fractures
with arthroplasty. All Morrey type II and III fractures of the coronoid
process was stabilized using lag screws.Aims
Patients and Methods
Promising medium-term results from total shoulder arthroplasty
(TSA) have been reported for the treatment of primary osteoarthritis
in young and middle-aged patients. The aim of this study was to
evaluate the long-term functional and radiological outcome of TSA
in the middle-aged patient. The data of all patients from the previous medium-term study
were available. At a mean follow-up of 13 years (8 to 17), we reviewed
21 patients (12 men, nine women, 21 shoulders) with a mean age of
55 years (37 to 60). The Constant-Murley score (CS) with its subgroups
and subjective satisfaction were measured. Radiological signs of implant
loosening were analysed.Aims
Patients and Methods
Rotator cuff tendinopathy has a multifactorial origin. Rejecting
the mechanistic theory has also led to abandoning operative treatment
at initial presentation in the first line. Physiotherapy exercise
programmes are the accepted first line treatment. The aim of this
study was to assess the long-term additional benefits of subacromial decompression
in the treatment of rotator cuff tendinopathy. This randomised controlled trial of 140 patients (52 men, 88
women, mean age 47.1 years; 18 to 60) with rotator cuff tendinopathy
extended previous work up to a maximum of 13 years. The patients
were randomised into two treatment groups: arthroscopic acromioplasty
and a supervised exercise treatment and a similar supervised exercise
treatment alone. Self-reported pain on a visual analogue scale (VAS)
was the primary outcome measure. Secondary measures were disability,
working ability, pain at night, Shoulder Disability Questionnaire
score and the number of painful days during the three months preceding
the final assessment.Aims
Patients and Methods
Radiostereometric analysis (RSA) allows an extremely accurate
measurement of early micromotion of components following arthroplasty. In this study, RSA was used to measure the migration of 11 partially
cemented fluted pegged glenoid components in patients with osteoarthritis
who underwent total shoulder arthroplasty using an improved surgical
technique (seven men, four women, mean age 68). Patients were evaluated
clinically using the American Shoulder and Elbow Surgeons (ASES)
and Constant-Murley scores and by CT scans two years post-operatively. Aims
Patients and Methods
Aims. We evaluated clinical and radiographic outcomes of total shoulder
arthroplasty (TSA) using the second-generation Trabecular Metal
(TM) Glenoid component. The first generation component was withdrawn
in 2005 after a series of failures were reported. Between 2009 and
2012, 40 consecutive patients with unilateral TSA using the second-generation
component were enrolled in this clinical study. The mean age of
the patients was 63.8 years (40 to 75) and the mean follow-up was
38 months (24 to 42). Methods. Patients were evaluated using the Constant score (CS), the American
Shoulder and Elbow Surgeons (ASES) score and routine radiographs. Results. Significant differences were found between the pre- and post-operative
CS (p = 0.003), ASES (p = 0.009) scores and CS subscores of pain
(p <
0.001), strength (p <
0.001) and
Frozen shoulder is a recognised complication
following simple arthroscopic shoulder procedures, but its exact incidence
has not been reported. Our aim was to analyse a single-surgeon series
of patients undergoing arthroscopic subacromial decompression (ASD;
group 1) or ASD in combination with arthroscopic acromioclavicular
joint (ACJ) excision (group 2), to establish the incidence of frozen
shoulder post-operatively. Our secondary aim was to identify associated
risk factors and to compare this cohort with a group of patients
with primary frozen shoulder. We undertook a retrospective analysis of 200 consecutive procedures
performed between August 2011 and November 2013. Group 1 included
96 procedures and group 2 104 procedures. Frozen shoulder was diagnosed
post-operatively using the British Elbow and Shoulder Society criteria.
A comparative group from the same institution involved 136 patients
undergoing arthroscopic capsular release for primary idiopathic
frozen shoulder. The incidence of frozen shoulder was 5.21% in group 1 and 5.71%
in group 2. Age between 46 and 60 years (p = 0.002) and a previous
idiopathic contralateral frozen shoulder (p <
0.001) were statistically
significant risk factors for the development of secondary frozen
shoulder. Comparison of baseline characteristics against the comparator groups
showed no statistically significant differences for age, gender,
diabetes and previous contralateral frozen shoulder. These results suggest that the risk of frozen shoulder following
simple arthroscopic procedures is just over 5%, with no increased
risk if the ACJ is also excised. Patients aged between 46 and 60
years and a previous history of frozen shoulder increase the relative
risk of secondary frozen shoulder by 7.8 (95% confidence interval
(CI) 2.1 to 28.3)and 18.5 (95% CI 7.4 to 46.3) respectively. Cite this article:
